数字健康干预在慢性病患者抑郁和焦虑中的应用：范围综述。
Digital Health Interventions for Depression and Anxiety Among People With Chronic Conditions: Scoping Review.
机构信息
Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
Centre for Global eHealth Innovation, University Health Network, Toronto, ON, Canada.
出版信息
J Med Internet Res. 2022 Sep 26;24(9):e38030. doi: 10.2196/38030.
BACKGROUND
Chronic conditions are characterized by their long duration (≥1 year), need for ongoing medical attention, and limitations in activities of daily living. These can often co-occur with depression and anxiety as common and detrimental comorbidities among the growing population living with chronic conditions. Digital health interventions (DHIs) hold promise in overcoming barriers to accessing mental health support for these individuals; however, the design and implementation of DHIs for depression and anxiety in people with chronic conditions are yet to be explored.
OBJECTIVE
This study aimed to explore what is known in the literature regarding DHIs for the prevention, detection, or treatment of depression and anxiety among people with chronic conditions.
METHODS
A scoping review of the literature was conducted using the Arksey and O'Malley framework. Searches of the literature published in 5 databases between 1990 and 2019 were conducted in April 2019 and updated in March 2021. To be included, studies must have described a DHI tested with, or designed for, the prevention, detection, or treatment of depression or anxiety in people with common chronic conditions (arthritis, asthma, diabetes mellitus, heart disease, chronic obstructive pulmonary disease, cancer, stroke, and Alzheimer disease or dementia). Studies were independently screened by 2 reviewers against the inclusion and exclusion criteria. Both quantitative and qualitative data were extracted, charted, and synthesized to provide a descriptive summary of the trends and considerations for future research.
RESULTS
Database searches yielded 11,422 articles across the initial and updated searches, 53 (0.46%) of which were included in this review. DHIs predominantly sought to provide treatment (44/53, 83%), followed by detection (5/53, 9%) and prevention (4/53, 8%). Most DHIs were focused on depression (36/53, 68%), guided (32/53, 60%), tailored to chronic physical conditions (19/53, 36%), and delivered through web-based platforms (20/53, 38%). Only 2 studies described the implementation of a DHI.
CONCLUSIONS
As a growing research area, DHIs offer the potential to address the gap in care for depression and anxiety among people with chronic conditions; however, their implementation in standard care is scarce. Although stepped care has been identified as a promising model to implement efficacious DHIs, few studies have investigated the use of DHIs for depression and anxiety among chronic conditions using such models. In developing stepped care, we outlined DHI tailoring, guidance, and intensity as key considerations that require further research.
背景
慢性疾病的特点是病程长（≥1 年）、需要持续的医疗关注以及日常生活活动受限。这些情况常常与抑郁和焦虑同时发生，是患有慢性疾病的人群中常见且有害的共病。数字健康干预（DHI）有望克服这些人群获取心理健康支持的障碍；然而，针对慢性疾病患者的抑郁和焦虑的 DHI 的设计和实施仍有待探索。
目的
本研究旨在探讨文献中已知的 DHI 在预防、检测或治疗患有慢性疾病的人群中的抑郁和焦虑方面的作用。
方法
使用 Arksey 和 O'Malley 框架对文献进行了范围综述。2019 年 4 月在 5 个数据库中进行了文献检索，并于 2021 年 3 月进行了更新。为了纳入研究，这些研究必须描述了一种针对常见慢性疾病（关节炎、哮喘、糖尿病、心脏病、慢性阻塞性肺疾病、癌症、中风、阿尔茨海默病或痴呆症）的预防、检测或治疗的 DHI，或者针对这些疾病设计的 DHI。由 2 名评审员独立根据纳入和排除标准对研究进行筛选。提取、图表和综合了定量和定性数据，以提供趋势的描述性总结和未来研究的考虑因素。
结果
两次数据库搜索共得到了 11422 篇文章，其中 53 篇（0.46%）被纳入了本综述。DHI 主要旨在提供治疗（44/53，83%），其次是检测（5/53，9%）和预防（4/53，8%）。大多数 DHI 主要关注抑郁（36/53，68%），以指导（32/53，60%），针对慢性身体疾病（19/53，36%），并通过网络平台（20/53，38%）提供。只有 2 项研究描述了 DHI 的实施。
结论
作为一个不断发展的研究领域，DHI 有潜力解决慢性疾病患者中抑郁和焦虑护理方面的差距；然而，它们在标准护理中的实施却很少。尽管阶梯式护理已被确定为实施有效 DHI 的有前途的模型，但很少有研究使用这种模型调查 DHI 在慢性疾病中的抑郁和焦虑治疗。在制定阶梯式护理时，我们概述了 DHI 的调整、指导和强度作为需要进一步研究的关键考虑因素。
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